Survival benefit of adjuvant chemotherapy based on molecular residual disease detection in resected colorectal liver metastases: subgroup analysis from CIRCULATE-Japan GALAXY.

BACKGROUND: The prognostic role of circulating tumor DNA (ctDNA)-based molecular residual disease (MRD) detection and its utility for postsurgical risk stratification has been reported in colorectal cancer. In this study, we explored the use of ctDNA-based MRD detection in patients with colorectal liver metastases (CLM), for whom the survival benefit of adjuvant chemotherapy (ACT) after surgical resection remains unclear. METHODS: Patients with CLM without extrahepatic disease from the GALAXY study (UMIN000039205) were included. The disease-free survival (DFS) benefit of ACT was evaluated in MRD-positive and -negative groups after adjusting for age, gender, number, and size of liver metastases, RAS status, and previous history of oxaliplatin for primary cancer. ctDNA was detected using a personalized, tumor-informed 16-plex polymerase chain reaction-next-generation sequencing (mPCR-NGS) assay. ctDNA-based MRD status was evaluated 2-10 weeks after curative surgery, before the start of ACT. RESULTS: Among 6061 patients registered in GALAXY, 190 surgically resected CLM patients without any preoperative chemotherapy were included with a median follow-up of 24 months (1-48 months). ctDNA positivity in the MRD window was 32.1% (61/190). ACT was administered to 25.1% (48/190) of patients. In the MRD-positive group, 24-month DFS was higher for patients treated with ACT [33.3% versus not reached, adjusted hazard ratio (HR): 0.07, P < 0.0001]; whereas no benefit of ACT was seen in the MRD-negative group (24-month DFS: 72.3% versus 62.2%, adjusted HR: 0.68, P = 0.371). Multivariate analysis showed that the size of liver metastases (HR: 3.94, P = 0.031) was prognostic of DFS in the MRD-positive group. In the MRD-negative group, however, none of the clinicopathological factors were prognostic of DFS. CONCLUSIONS: Our data suggest that ACT may offer notable clinical benefits in MRD-positive patients with CLM. MRD status-based risk stratification could be potentially incorporated in future clinical trials for CLM.

Ramucirumab plus FOLFIRI as second-line treatment for patients with RAS wild-type metastatic colorectal cancer previously treated with anti-EGFR antibody: JACCRO CC-16.

BACKGROUND: Chemotherapy in combination with anti-epidermal growth factor receptor (EGFR) antibody is considered a first-line treatment regimen for RAS wild-type and left-sided metastatic colorectal cancer (mCRC), whereas second-line treatment regimens have not yet been established. Few studies have prospectively evaluated second-line treatment with anti-vascular endothelial growth factor antibody after first-line anti-EGFR antibody therapy for RAS wild-type mCRC. PATIENTS AND METHODS: This non-randomized phase II trial investigated the clinical outcomes of second-line ramucirumab (RAM) plus fluorouracil, levofolinate, and irinotecan (FOLFIRI) after first-line anti-EGFR antibody in combination with doublet or triplet regimen in patients with RAS wild-type mCRC. The primary endpoint was the 6-month progression-free survival (PFS) rate. The secondary endpoints were PFS, overall survival (OS), objective response rate (ORR), rate of early tumor shrinkage (ETS), and safety. We hypothesized a threshold 6-month PFS rate of 30% and an expected 6-month PFS rate of 45%. Treatment was considered effective if the lower limit of the 90% confidence interval (CI) of the 6-month PFS rate was >0.30. RESULTS: Ninety-two patients were enrolled in the study. The primary tumor was located on the left side in 86 (95.6%) patients. Twenty (22.0%) patients had received triplet plus cetuximab as previous therapy. Six-month PFS rate was 58.2% (90% CI 49.3% to 66.2%) with a median PFS of 7.0 months (95% CI 5.7-7.6 months). Median OS was 23.6 months (95% CI 16.5-26.3 months). The ORR and ETS rate were 10.7% and 16.9%, respectively, in 83 patients with measurable lesions. The 6-month PFS rate was comparable between patients previously treated with doublet and triplet regimens; however, median PFS was longer for the doublet regimen (7.4 versus 6.4 months, P = 0.036). CONCLUSIONS: Our study demonstrated prospectively that RAM plus FOLFIRI is an effective second-line treatment after anti-EGFR antibody-containing first-line therapy in RAS wild-type and left-sided mCRC. Furthermore, the results were similar for patients who were previously treated with triplet regimen.

Muscular Echo-Intensity of the Quadriceps by Ultrasound Is More Related to Improvement of Gait Independence than Muscle Thickness in Older Inpatients.

OBJECTIVES: This study aimed to examine whether the decrease in muscular echo-intensity of the quadriceps by ultrasound in older inpatients is related to the improvement of gait independence than the increase of muscle thickness. DESIGN: Longitudinal study. SETTING: Hospital-based study. PARTICIPANTS: This study included 171 inpatients aged ≥ 65 years (median age: 84.0 [77.0-88.0], 56.1% female). Patients who were able to walk independently at hospital admission were excluded from the study. MEASUREMENTS: Improvement of gait independence during hospital stay was assessed using the change in Functional Independence Measure (FIM) gait score (i.e., FIM gait score at hospital discharge minus FIM gait score at hospital admission) and FIM gait score at hospital discharge. Muscular echo-intensity and muscle thickness of the quadriceps were assessed at hospital admission and discharge using ultrasound images, respectively. Muscular echo-intensity has been shown to be mainly related to intramuscular adipose tissue. Multiple linear regression analysis was performed to identify the factors independently associated with the change in FIM gait score and FIM gait score at discharge. RESULTS: Change in quadriceps echo-intensity was independently and significantly associated with the change in FIM gait score (ß = -0.22, p = 0.017) and FIM gait score at hospital discharge (ß = -0.21, p = 0.017). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in FIM gait score (ß = 0.16, p = 0.050) and FIM gait score at hospital discharge (ß = 0.15, p = 0.050). CONCLUSIONS: Our study indicates that a decrease in muscular echo-intensity of the quadriceps by ultrasound is more related to the improvement of gait independence than an increase of muscle thickness in older inpatients. Intervention for intramuscular adipose tissue of the quadriceps may be important for improving gait independence in older inpatients.

Higher Body Mass Index in Hospitalized Older Patients Is Related to Higher Muscle Quality.

OBJECTIVES: This study aimed to examine the relationship between muscle mass, intramuscular adipose tissue, and body mass index (BMI) in older inpatients. DESIGN: Cross-sectional study. SETTING: Hospital-based study. PARTICIPANTS: This study included 413 inpatients aged ≥ 65 years (186 men and 227 women). MEASUREMENTS: Muscle mass and intramuscular adipose tissue of the quadriceps were assessed by measuring the muscle thickness and echo intensity on ultrasound images. To examine the relationship between quadriceps thickness and echo intensity and BMI in total participants and each sex, the Kendall rank correlation coefficient was used. Multiple regression analysis was performed to examine whether BMI was independently and significantly related to the quadriceps thickness and echo intensity, even after adjusting for other variables for total participants and each sex. The independent variables in multiple regression analyses were BMI, age, disease, days from onset disease. RESULTS: The results of the correlation analyses showed that BMI was significantly related to the quadriceps thickness (total participants, τ = 0.431; men, τ = 0.491; women, τ = 0.388) and echo intensity (total participants, τ = -0.239; men, τ = -0.318; women, τ = -0.188). In the multiple regression analysis, BMI was independently and significantly associated with the quadriceps thickness (total participants, ß = 0.535; men, ß = 0.548; women, ß = 0.519) and echo intensity (total participants, ß = -0.287; men, ß = -0.398; women, ß = -0.210). CONCLUSION: This study indicated that older inpatients with a higher BMI have greater muscle mass and less intramuscular adipose tissue of the quadriceps. These results suggested that a higher BMI in older inpatients is related to higher quadriceps muscle quality.

Effect of habitual exercise on urinary liver-type fatty acid-binding protein levels in middle-aged and older adults.

The purpose of this study was to examine the effect of habitual exercise on urinary liver-type fatty acid-binding protein (L-FABP), which can reflect the degree of various stresses on renal proximal tubule related to the progression of renal disease, in middle-aged and older adults. Cross-sectional and interventional approaches were used to comprehensively achieve this purpose. In the cross-sectional study, we investigated the relationship between physical activity levels and urinary L-FABP levels in 130 middle-aged and older adults. In the interventional study, subjects (n=31) were divided into two groups: exercise (n=19) and control group (n=12), whereby we examined the effects of 12-week aerobic exercise training on urinary L-FABP levels. The cross-sectional study showed that the urinary L-FABP levels were significantly lower in the higher physical activity group than in the lower physical activity group (P<.05). In the interventional study, 12-week aerobic exercise training significantly decreased urinary L-FABP levels (P<.01). Furthermore, the relative changes in urinary L-FABP levels were significantly correlated with the relative changes in physical activity levels and mean arterial pressure after intervention (r=-.374 and r=.530, respectively). Our results revealed that the urinary L-FABP levels were lower in the higher physical activity individuals, and aerobic exercise training decreased urinary L-FABP levels. These results suggest that habitual exercise appears to be associated with a decrease in the degree of several stresses on renal proximal tubule and to be beneficial for kidney health in middle-aged and older adults.

[Multi-institutional cooperative study on combination chemotherapy with THP, CDDP and 5-FU for squamous cell carcinoma of the head and neck].

Combination chemotherapy with THP, CDDP and 5-FU for squamous cell carcinoma of the head and neck was conducted in 13 institutions in Hyogo Prefecture as a multi-institutional cooperative study. In the initial study (Nov. 1990-Nov. 1993), THP was administered intravenously at 20 mg/m2 on day 1, CDDP at 80 mg/m2 on day 2, and 5-FU at 1,000 mg/body/day in a continuous drip infusion for 120 hours from day 2 to day 6. In the second study (May, 1996-Mar. 1998), THP was administered at 20 mg/m2 on day 1, 5-FU at 10 mg/kg/day from day 1 to day 5, and CDDP at 70 mg/m2 on day 6 in the same way as the initial study. Forty-nine patients (Stage I in 3, Stage II in 12 including 2 recurrent cases, Stage III in 6, Stage IV in 28 including 3 recurrent cases; 1 course chemotherapy in 13 and 2 or more courses in 36) were subjected as complete cases in the initial study, and 36 patients (Stage I in 5 including one recurrent case, Stage II in 11 including 1 recurrent case, Stage III in 9 including 2 recurrent cases, Stage IV in 11 including one recurrent case; 1 course in 18 and 2 or more courses in 18) in the second. The overall response rate was 65.3% (CR in 3 cases) in the initial study and 63.9% (CR in 5 cases) in the second. Primary cases showed a response rate of 65.9% (29/44) in the initial study and 71.0% (22/31) in the second, whereas recurrent cases showed a 60.0% (3/5) response rate in the initial study and a 20.0% (1/5) rate in the second. Treatment-naive patients showed a response rate of 72.7% (24/33) in the initial study and 71.0% (22/31) in the second, whereas previously treated patients showed a 50.0% (8/16) response rate in the initial study and a 20.0% (1/5) rate in the second. Adverse reactions of more than Grade 3 in the initial study were leukopenia in 18.4%, thrombocytopenia in 8.2%, decrease of hemoglobin in 6.1%, loss of hair in 6.1%, anorexia in 36.7%, nausea and vomiting in 26.5%, and diarrhea in 4.1%, whereas those of Grade 3 in the second study were decrease of hemoglobin in 2.8%, anorexia in 22.2% and nausea and vomiting in 8.3%. From these results, it is suggested that the regimen in the second study was more useful than that in the initial study.

Studies on the constituents of Broussonetia species. III. Two new pyrrolidine alkaloids, broussonetines G and H, as inhibitors of glycosidase, from Broussonetia kazinoki Sieb.

Two new pyrrolidine alkaloids, broussonetines G and H, were isolated from the branches of Broussonetia kazinoki SIEB. (Moraceae). Broussonetines G and H were formulated as 2 beta-hydroxymethyl-3 alpha, 4 beta-dihydroxy-5 alpha-(1-hydroxy- 6:10;10:13-diepoxytridecyl)-pyrrolidine (1) and 2 beta-hydroxymethyl-3 alpha, 4 beta-dihydroxy-5 alpha-(1-hydroxy- 5:9;9:13-diepoxytridecyl)-pyrrolidine (2), respectively, by spectroscopic methods. 1 and 2 inhibited beta-glucosidase, beta-galactosidase and beta-mannosidase.

Studies on the constituents of Broussonetia species. II. Six new pyrrolidine alkaloids, broussonetine A, B, E, F and broussonetinine A and B, as inhibitors of glycosidases from Broussonetia kazinoki Sieb.

Six new pyrrolidine alkaloids called broussonetine A, B, E, F, and broussonetinine A and B were isolated from the branches of Broussonetia kazinoki Sieb. (Moraceae). Broussonetine A, B, E and F were formulated as 2 beta-hydroxymethyl-3 beta-hydroxy-5-alpha- (10-oxo-13-hydroxytridecyl)-pyrrolidine-4-O-beta-D-glucopyranoside (1), 2 beta-hydroxymethyl-3 beta-hydroxy-5 alpha-(9-oxo-13-hydroxytridecyl)-pyrrolidine-4-O-beta-D-glucopy ran oside (2), 2 beta-hydroxymethyl-3 alpha,4 beta-dihydroxy-5 alpha-(1,13-dihydroxy-10-oxo-tridecyl)-pyrrolidine (3), and 2 beta-hydroxymethyl-3 alpha,4 beta-dihydroxy-5 alpha-(1,13-dihydroxy-9-oxo-tridecyl)-pyrrolidine (4), respectively. Broussonetinine A and B (5 and 6) were also isolated and identified as the aglycones of 1 and 2. 3 and 4 exhibited a strong inhibition of alpha-glucosidase, beta-glucosidase, beta-galactosidase and beta-mannosidase, while 5 and 6 showed a strong inhibition of beta-galactosidase and alpha-mannosidase.

The independent association of smoking and drinking with serum beta-carotene levels among males in Miyagi, Japan.

BACKGROUND: Previous studies indicated that serum beta-carotene levels were low among smokers and drinkers. However these findings may result from the strong relationship between smoking and drinking. METHODS: Data were collected from 1902 males randomly selected from participants of a cohort study. The effects of smoking on serum beta-carotene levels were assessed according to drinking status (non-drinker, ex-drinker and current drinker), and those of drinking were assessed according to smoking status (ex-smoker and current smoker) using general linear model including other factors (age, intake of green-yellow vegetables, intake of carrot or pumpkin, body mass index serum cholesterol levels.) RESULTS: An inverse dose-response relationship between daily consumption of alcohol and beta-carotene levels was observed regardless of smoking status, and also between number of cigarettes smoked per day and beta-carotene levels regardless of drinking status. CONCLUSION: These results suggest that cigarette smoking and alcohol drinking reduce beta-carotene levels independently.

Gradient-index rod lens with a high acceptance angle for color use by Na(+) for Li(+) exchange.

The relationship between the characteristics of gradient-index rod lenses obtained by ion exchange and their mother glass compositions is studied. It is observed that Li(2)O content, R(2)O (Li(2)O + Na(2)O) content, and the Li(2)O/Na(2)O ratio are important factors in attaining a high acceptance angle and a small field curvature. Thus the gradient-index lens array is fabricated by the use of a newly developed glass composition and its optical performance; the modulation transfer function, luminous intensity, and chromatic aberration are precisely evaluated. The array is found to have a sufficiently high performance to be applicable for color use.

[Parapharyngeal space lesions: with a reference to biopsy].

We received seven cases of parapharyngeal space lesions and discussed on necessity of biopsy. Tumors originating in the parapharyngeal space were represented by parotid pleomorphic adenomas which showed bulging of soft palate and tonsillar fossa, and benign neurogenic tumors which showed bulging of the lateral wall of the meso-pharynx. In these cases, preoperative biopsy was not necessary unless the lesion was suspected, of malignancy by CT, MRI and so on. In the case of bulging of soft palate and tonsillar fossa, if CT or MRI finding shows that the tumor is localized in the median portion of the parapharyngeal space and is separated from greater vessels and nerves existing in the parapharyngeal space, therapeutic protocol might be planned after an establishment of histological diagnosis with biopsy. In the case of a bulging lateral wall of the meso-pharynx with a history of malignant neoplasm of the head and neck, lymph node metastasis should be thought about.

Effects of vitamin A deficiency on the function of pituitary-gonadal system in male rats.

The effects of vitamin A deficiency on the pituitary-gonadal function were examined by measurements of serum and pituitary level of pituitary hormones and serum testosterone concentration, and by investigations of histological changes in the testis and the pituitary gland in vitamin A-deficient (VAD) and supplemented (VAS) rats. The growth of VAD rats was retarded and their body weights were decreased after 9 weeks of experiments and attained about one half of the weight of control animals at 12 weeks. In the VAD rats, serum testosterone concentrations were decreased significantly compared with those in the VAS controls. Serum and pituitary concentrations of GH were significantly lower but those of LH were slightly lower in the VAD rats than those in the controls, while the serum FSH concentration was significantly higher than that in the control rats. The seminiferous tubules in the testes of VAD rats were comprised largely of Sertoli cells and a reduced number of spermatogonia and contained fibrous formation in their lumen. In the pituitary gland, GH cells were significantly reduced in number in the VAD rats, but gonadotropic (GTH) cells were increased remarkably in size and number, showing hypertrophy and vacuolation similar to those in castration cells. The cytological changes in the pituitary gland and the increased discharge of FSH represent a secondary and compensatory change similar to that seen following castration and vitamin E deficiency.

[Clinical study of ofloxacin in complicated urinary tract infection].

Ofloxacin (OFLX) was administered at a dose of 200 mg, three times daily (600 mg) for 14 days, to 15 patients suffering from complicated urinary tract infection. According to the criteria for clinical evaluation by the UTI committee, excellent and moderate responses were seen in 54% at 5 days evaluation, and in 91% at 14 days evaluation. No serious side effects were recognized and no changes in laboratory examination data were observed. We conclude that OFLX was useful in treatment of urinary tract infection.

[Treatment of advanced bladder cancer with intra-arterial infusion of cisplatinum (CDDP) and aclacinomycin (ACR), combined with angiotensin II].

Ten patients with advanced bladder cancer were treated with intra-arterial infusion therapy. The patients consisted of nine males and one female between 55 and 82 years old (median: 70 years). In all patients, cisplatinum (CDDP) (2 mg/kg), aclacinomycin (ACR) (0.5 mg/kg) and Angiotensin II (25 mg) were infused via the internal iliac artery for a period of about 30 minutes. Seven patients also received X-ray therapy with a linac. The efficacy of this therapy was assessed by computed tomographic scanning, sonography and cystoscopy. As a result of this assessment, 2 patients were rated complete response "(CR)", 6 partial response (PR) (showing 50% or more reduction in the lesion) and 2 no change "(NC)". To compare the efficacy of this therapy for two histopathologically defined groups of patients (patients with grades 2 and 3 cancer), one patient was rated "CR", four "PR" and two "NC" in the grade 3 group (total 7 patients), while one was rated "CR" and two "PR", in the grade 2 group (total 3 patients). In effective cases, pollakiuria and miction pain disappeared shortly following intra-arterial infusion therapy. As for side effects of the therapy, mild nausea or vomiting was observed in all patients, while leukopenia was noted in one patient.

Effects of vitamin E deficiency on the hormone secretion of the pituitary-gonadal axis of the rat.

Chronological changes of gonadotropin (FSH and LH) and testosterone concentrations in the serum were measured in vitamin E deficient rats to investigate the effects of vitamin E deficiency on the pituitary-gonadal function in rats. The receptor sites and association constant (Ka) for LH and the formation of cyclic AMP in the Leydig cells were also investigated. The results obtained in the present study are as follows: 1) The vitamin E deficient rats showed almost complete hemolysis and extremely increased TBA reacting substances (TBARS) in the serum and liver. 2) The serum LH concentration in the vitamin E deficient group was slightly higher than in the vitamin E supplemented group during the later periods of experiment. 3) The serum FSH concentration in the vitamin E deficient group did not differ significantly from that in vitamin E supplemented group, but became significantly higher than that in the latter at 186 days of experiment. 4) The serum testosterone concentration was always lower in the vitamin E deficient group than in the control. 5) The vitamin E deficient group showed slightly large number of LH/hCG receptor and significantly small Ka (low affinity), as compared with vitamin E supplemented group. The formation of cyclic AMP by Leydig cells decreased significantly in vitamin E deficient group. These results suggest that the vitamin E deficiency exerted a suppressive effect directly on the gonadal function to decrease the hormone synthesis in the Leydig cells and caused the increased secretion of pituitary LH owing to the feedback mechanism.

Effects of vitamin E deficiency and non-biological antioxidant (DPPD) on the function of the pituitary-gonadal axis of the rat.

The effects of vitamin E deficiency on pituitary-gonadal function in rats and the preventive effects of N,N'-diphenyl-p-phenylene diamine (DPPD) administration were examined by measuring levels of pituitary and plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH), serum and testicular levels of testosterone, and affinity and receptor sites of FSH and LH in the testis by radioimmunoassay, at 180 days after feeding of a vitamin E-deficient diet and DPPD-administered diet. Light and electron microscopic examinations were also performed on the pituitary gland and testis. In the vitamin E-deficient rats, serum and liver alpha-tocopherol concentrations decreased significantly and erythrocyte hemolytic rate and serum and tissue malondialdehyde levels increased significantly. However, the increase of hemolytic rate and malondialdehyde concentration in the vitamin E-deficient rats was somewhat lessened by the administration of DPPD. In the vitamin E-deficient rats, the gonadotropic cells in the pituitary gland manifested accelerated secretory function indicated by enlargement of cells, development of Golgi apparatus and accumulation of secretory granules, while FSH and LH concentrations in the pituitary and serum were not affected by vitamin E deficiency. However, the testosterone concentrations in the plasma and testis were significantly lower in the vitamin E-deficient rats. The decrease of testosterone in plasma and tissue was prevented by the administration of DPPD, while the degeneration of seminiferous tubules was not completely restored by DPPD. It is concluded that DPPD can compensate to some degree for the lack of antioxidative activity due to vitamin E deficiency.

Malignant fibrous histiocytoma originating in the left spermatic cord with a review of 14 cases in the literature.

An 84-yr-old man developed a small-finger-tip sized tumor in the left inguinal area about five to six years prior to consultation with the Urology Department. Later, the tumor extended to the scrotum and the suprapubic area. Histological examination of an en block specimen showed the tumor to be a malignant fibrous histiocytoma of spermatic cord origin. Fourteen cases in the worldwide literature are reviewed, and characteristics of malignant fibrous histiocytoma at this particular site are discussed.

[Prostatic tissue and fluid levels of DL-8280].

The concentration of DL-8280, a new pyridone carboxylic acid, in the prostatic tissue and fluid after oral administration to man was studied. The drug was concentrated in the prostate and the concentration was dose-dependent. The ratios of prostatic tissue and fluid levels to serum levels were 1.62-1.79 and 1.65-1.96. respectively.